In a recent issue of Diabetes Care , Pershadsingh and Kurtz (1) reported an interesting case subject with impaired glucose tolerance, whose insulin resistance and triglycerides improved on the angiotensin II type 1 receptor blocker telmisartan. Telmisartan has a unique agonist activity of the peroxisome proliferator–activated receptor γ (PPARγ) in vitro (2). It reduces glucose, insulin, and triglyceride levels in rats fed a high-fat, high-carbohydrate diet (2). These results suggest that telmisartan may have a beneficial effect on glycemic control in type 2 diabetes.
We investigated the effect of …
Thyroid follicles in the lateral position of the neck are usually thought to represent the metastasis of thyroid carcinoma. Here we present a case of a 28-year-old woman with accessory ectopic thyroid associated with Graves' disease. Despite a history of Graves' disease poorly controlled with large dose propylthiouracil she was found to be pregnant and artificial abortion was planned. Thyroid scintigraphy was carried out, which indicated an uptake into the region above the left lobe as well as into both lobes of the thyroid gland. In order to control hyperthyroidism and to exclude the possibility of metastasis, total thyroidectomy with tumor resection was performed before the artificial abortion. Pathological examinations of the thyroid gland indicated findings compatible with Graves' disease. The lateral neck mass was revealed to be composed of nonneoplastic thyroid tissue, showing similar histological findings to those of the goiter, which were consistent with Graves' disease. Taken together with several previous reports, it appears that there are some cases with lateral ectopic thyroid tissue, whose pathogenetic mechanism remains to be elucidated.
Abstract The interaction of galanin (GAL) with serotonin (5‐HT) in the regulation of prolactin (PAL) secretion was investigated in urethaneanesthetized male rats. Intracerebroventricular administration of 5‐HT (1 and 10 μ g) and GAL (1 μ g) caused an increase in plasma PRL levels, but co‐administration of GAL did not show any additive effect on 5‐HT‐induced PRL secretion. Pretreatment with methysergide (0.25 mg/kg), a nonselective 5‐HT1 and 5‐HT2 receptor antagonist, partially inhibited the PRL increase induced by GAL. On the other hand, neither ketanserin (0.25 mg/kg), a selective 5‐HT2 receptor antagonist, nor ICS 205–930 (0.25 mg/kg), a selective 5‐HT3 receptor blocker, had any effect on GAL‐induced increase in PRL secretion. Parachlorophenylalanine (300 mg/kg), a 5‐HT synthesis inhibitor, however, caused a marked enhancement of PRL release induced by GAL, which was partially inhibited by a 5‐HT neurotoxin, 5, 6‐dihydroxytryptamine. Parachlorophenylalanine also caused a potentiation of 5‐HT‐induced PRL release, possibly by sensitizing 5‐HT receptors. These findings suggest that 5‐HT receptors are, at least partly, involved in GAL‐induced PRL release in the rat.
Abstract Aims To elucidate varicella zoster virus ( VZV )‐specific cell‐mediated immunity and humoral immunogenicity against live attenuated Oka varicella zoster vaccine concurrently vaccinated with 23‐valent pneumococcal polysaccharide vaccine ( PPSV 23) in elderly people with diabetes mellitus. Methods This double‐blind randomized controlled single‐centre study of 60–70‐year‐old people with diabetes compared immunity and safety profiles 3 months after one dose of varicella zoster vaccine or placebo. PPSV 23 was immunized simultaneously. Primary analysis evaluated cell‐mediated immunity using the VZV skin test. Secondary analyses were a VZV interferon–γ enzyme‐linked immunospot ( ELISPOT ) assay and immunoadherence haemagglutination test. Adverse experiences were recorded using diary questionnaires. Results By intent‐to‐treat analysis, 27 participants with diabetes who had been administered the vaccine were compared with 27 participants who were given a placebo. Changes in skin test scores were 0.41 ± 0.80 and 0.11 ± 0.93 ( P = 0.2155), and geometric mean fold rises of the ELISPOT counts were 1.2 [95% confidence interval ( CI ) 0.2, 7.9] and 1.2 (95% CI 0.2, 7.3) ( P = 0.989) in the vaccine and placebo groups, respectively. The geometric mean titre did not increase 3 months after vaccination in either group. No vaccination‐related severe adverse experience was reported and no participant developed herpes zoster. Discussion Our previous results demonstrated that varicella zoster vaccine safely enhanced VZV ‐specific immunity in elderly people with or without diabetes. The results of this study showed that varicella zoster vaccine can be used safely, but it cannot boost virus‐specific immunity in elderly people with diabetes when administered with concurrent PPSV 23. Alternative strategies are needed to prevent VZV ‐associated diseases in this population.
We read with interest the article by Izumino et al. (1), which suggests a therapeutic use of troglitazone, an insulin sensitizer, in Werner's syndrome as well as in noninsulin-dependent diabetes mellitus (NIDDM).We here report another possible benefit of troglitazone treatment: prevention of atherosclerosis.We measured the intimal and medial complex thickness (IMT) of common carotid artery using B-mode ultrasound technique to evaluate early atherosclerotic lesions (2).First we investigated the relationship between IMT and urinary C-peptide levels (u-CPR) or insulin dosage in 106 Japanese subjects with NIDDM [52 males and 54 females, age 62.5 yr (se 0.9) yr].Eighty-one of them were receiving insulin treatment, and the others were taking sulfonylureas.u-CPR of 24-hr urine samples were measured with a radioimmunoassay kit and were expressed as a mean value in three consecutive days.IMT values showed a positive correlation with both u-CPR (r ϭ 0.655, P Ͻ 0.0001) and insulin dosage, calculated as an average dose per day (r ϭ 0.399, P Ͻ 0.005).The correlation remained significant after adjusting for HbA Ic , body mass index, age, serum total cholesterol, and triglyceride levels.Second, we examined the effect of short-term treatment with troglitazone (400 mg daily for 3 months) on IMT in 33 patients with NIDDM.Before troglitazone treatment they had been treated with sulfonylureas (32 glibenclamide and 1 gliclazide), which were continued in the same doses during the troglitazone treatment.Thirty-two diabetic subjects (29 receiving sulfonylureas and 3 diet alone) were examined as control group.The group given troglitazone showed a significant decrease in IMT after 3 months [IMT change: Ϫ0.196 mm (se 0.082) vs. control 0.034 mm (se 0.010), P Ͻ 0.01].There was no relation between a decrease in IMT and a decline in HbA Ic .Our finding indicated an association of IMT with both endogenous and exogenous insulin in NIDDM.It is in contrast with a previous study, which failed to demonstrate an association of serum C-peptide with IMT in NIDDM (3), but is compatible with another report indicating an association of fasting insulin and IMT in normal subjects (4).It is also intriguing that we found an analogous association between lumbar bone mineral density and endogenous or exogenous insulin in NIDDM (5).It is possible that the association of IMT with insulin may reflect a direct or indirect atherogenic action of insulin on the vascular wall.However, troglitazone markedly decreased IMT, suggesting that the correlation of IMT and insulin represents a relationship between atherosclerosis and insulin resistance rather than the actions of insulin.Negative association has recently been reported between IMT and insulin sensitivity (6).Alternatively, it is possible that insulin has both atherogenic and antiatherogenic actions, but insulin resistance may selectively inhibit the antiatherogenic action (7), which can be reversed by troglitazone treatment.However, actions of troglitazone other than those as an insulinsensitizer, such as antioxidant activity (8), cannot be totally excluded.Whatever the mechanisms, the present preliminary result suggests a potent inhibitory action of troglitazone on atherosclerosis, which is compatible with a study in the rat (9).Since Werner's syndrome is characterized with progeria (1), it is of interest to investigate whether IMT is increased and whether troglitazone may decrease IMT in this disorder.It is also to be elucidated whether troglitazone may prevent restenosis after coronary angioplasty in NIDDM.
